THE global disease and death forecast by the World Health Organization (see 鈥淲hat will be ailing us in a generation鈥檚 time鈥�) is an exercise in the art of the possible. The authors know it is only a best guess, but it is a guess that needs to be made if only to get biomedical researchers pointing in the right direction.
One assumption underlying the prediction is that the future will be like the past. That may prove false. Wealth is what mostly determines what people sicken and die of. As countries have gone from poor to rich, they have undergone an 鈥渆pidemiological transition鈥� from diseases of filth like diarrhoea, to diseases of affluence like diabetes. The WHO assumed this will hold in future, then effectively turned the World Bank鈥檚 prosperity forecast into a disease forecast. It will, therefore, be wrong if the World Bank is wrong.
Some of its predictions do look improbably rosy 鈥� and that鈥檚 before factoring in climate change. Even if they are accurate, can we be confident that wealth will change disease in Malawi the same way it did in South Korea? The last time the WHO made a prediction like this it grossly underestimated the impact of a virus from Africa: HIV. It seems likely that more such surprises will surface. Predictions are one thing, but biomedical researchers need to prepare for the unexpected.
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